Provider Demographics
NPI:1417497421
Name:CAMELOT COUNSELING OF STATEN ISLAND
Entity Type:Organization
Organization Name:CAMELOT COUNSELING OF STATEN ISLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:NASTA
Authorized Official - Suffix:
Authorized Official - Credentials:CASAC
Authorized Official - Phone:718-356-5100
Mailing Address - Street 1:4442 ARTHUR KILL ROAD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-1304
Mailing Address - Country:US
Mailing Address - Phone:718-356-5100
Mailing Address - Fax:718-356-3155
Practice Address - Street 1:4442 ARTHUR KILL ROAD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-1304
Practice Address - Country:US
Practice Address - Phone:718-356-5100
Practice Address - Fax:718-356-3155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health